Outsiders Won’t Fix N.C. Medicaid
By Robert Seligson, CEO
North Carolina Medical Society
We are in unequivocal agreement with at least one crucial aspect of Governor McCrory’s recent proposal to reform our state’s Medicaid program – it needs to be fixed and fast.
The NCMS is committed to working with the governor and the legislature to ensure that any reforms implemented put the patient first. We understand that our health care system is broken.
It’s our mission to help physicians lead the way in making positive changes to our system that focus on the patient’s welfare first and foremost.
To that end, we have dedicated ourselves to eliminating the “silos” between caregivers, hospitals, insurers and other payers. We are working with the hospitals and Blue Cross Blue Shield of North Carolina among others to better design our delivery and payment system to realize optimum results for patients and ultimately reduce costs.
As an organization that has been around for over 150 years, we’ve learned from history, and we were hopeful that the current administration would, too. Several years ago, North Carolina put the Medicaid Management Information System (MMIS) out to bid in hopes of providing a better data and reimbursement system at a competitive price. The lowest bidder, at $265 million, received the award back in 2009, and, as detailed by numerous media accounts and by the current Governor’s own staff, the state changed vendors and extended the project for a total of $494 million of tax payer money trying to get the system right. To date it is still not up and running, however, the new administration is hopeful it will be ready this summer.
Let’s learn from this fiasco. Tying our Medicaid program to outside corporations to “fix” the program is not the answer. Quality health care for our citizenry doesn’t lie in negotiating a strong contract with a private company to gain predictability for the state budget. Ensuring the best for our citizens means the leaders of our state remain accountable for the kind of health care provided, and the cost savings if that care results in a healthier population. Any savings generated by the contracted corporations would go into the managed care companies’ wallets instead of into state coffers.
Our own Community Care of NC (CCNC), a statewide, collaborative care network of over 5,000 primary care providers is the envy of the country and already has a track record of saving the state millions of dollars, and providing excellent health care and access to our citizens. By expanding this proven model to include specialists to treat the whole patient and continue to create savings through prevention and patient contact, the savings that result will accrue back to North Carolina, not an out-of-state corporate “entity.”
These are complex issues that do indeed require a close partnership with everyone involved. Even individuals need to look at their own behavior, and how it affects their health. A culture change needs to occur in which citizens assume more personal responsibility for taking care of themselves through exercise and eating right. Without this most elemental change in how the public views health care, the cost to all of us will never be controllable.
The NCMS is ready to move ahead with innovative new ways of fixing our broken system for the health of North Carolina’s citizens. We do not want to repeat the mistakes of the past.